Objective: To assess the frequency and outcomes of impulsivity in study participants receiving bilateral subthalamic deep brain stimulation (STN-DBS) for the treatment of Parkinson’s Disease (PD).

Background: The relationship between STN-DBS and impulse control disorders (ICD) is complex and has been the subject of largely retrospective, uncontrolled studies that have yielded heterogeneous findings. Small retrospective studies evaluating participants before and after STN-DBS surgery have revealed both positive and negative results; while several studies have shown reduction of pre-existing behaviors, others have revealed worsening. De novo ICDs following STN-DBS have also been reported. There is limited knowledge regarding the factors and their interactions  accounting for these different outcomes.

Method: INTREPID (ClinicalTrials.gov: NCT01839396) was a multi-center, prospective, double-blinded, randomized controlled trial. Participants with advanced PD were implanted bilaterally in the STN and completed a neuropsychological battery at screening (prior to DBS) and at follow-up (12-months). Impulsivity was examined using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease–Rating Scale (QUIP-RS). A higher QUIP-RS score indicated greater severity (frequency) of symptoms. Total QUIP-RS scores (ranging from 0-64) and ratings for individual ICD behavior(s) were also evaluated. Clinically significant ICD was defined as a QUIP-RS score >22.

Results: At 1-year post STN-DBS, 32 of 160 participants (20%) reported a >5 point improvement in QUIP-RS ICD scores, and 7 (4.3%) showed a >10-point improvement. Nineteen (11.8%) participants had a >5 point worsening, and 8 (5%) reported a worsening of >10. Analysis[TA-S1] of relevant demographic information, appearance of ICD and clinical factors including antiparkinsonian medications, lead location, programming settings and structural as well as functional connectivity data will be presented.

Conclusion: The data at 1-year follow-up following bilateral STN-DBS revealed both improvement and worsening in ICDs as well as a few de novo cases. Clinicians should be aware of these critically important management issues and appropriate pre-operative counseling and post-operative monitoring should be employed.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impulse-control-disorders-following-bilateral-subthalamic-deep-brain-stimulation-for-parkinsons-disease-the-intrepid-randomized-controlled-trial-2/